John Hopkins Center for Health Security Update 4/1

April 1, 2020
EPI UPDATE The WHO COVID-19 Situation Report for March 31 reported 750,890 confirmed COVID-19 cases (57,610 new) and 36,405 deaths (3,301 new) globally. No new countries reported COVID-19 cases. If the recent trend continues, the pandemic could reach 1 million cases and 50,000 deaths in the next 5 days.
The Russian Ministry of Health reported a total of 2,765 cases (439 new), an increase of 18% from the previous day. Iran reported 47,593 confirmed cases of COVID-19 (2,987 new), including 3,036 deaths (138 new). Pakistan reported 2,039 confirmed cases on April 1, more than doubling its national total a week ago (991 cases on March 25).
The US CDC reported 163,539 cases (22,635 new) and 2,860 deaths (455 new) on March 31. As of yesterday, 7 states have reported more than 5,000 cases, and 20 states have reported widespread community transmission. The Johns Hopkins CSSE dashboard is reporting 190,740 US cases and 4,127 deaths as of 12:00pm on April 1. Notably, New York state reported 9,298 new cases yesterday, bringing the statewide total to 75,795—a daily increase of 14%. New York City has reported 43,139 of these cases, including 5,686 of the newly reported cases—a daily increase of 15.2% (New York state March 30 report).
The New York Times is compiling national-level COVID-19 incidence data to track the epi curves in real time.
US COVID-19 PROJECTIONS The US Coronavirus Task Force presented updated projections for US COVID-19 epidemic. The discussion included rationale behind recent orders to extend social distancing. Based on available modeling, notably by the Institute for Health Metrics and Evaluation, the US government projects at least 100,000 deaths nationwide, under continued and effective implementation of social distancing measures.
US COVID-19 REPATRIATION Yesterday, US Secretary of State Mike Pompeo urged US citizens currently overseas that wish to return home to do so as quickly as possible. Secretary Pompeo emphasized that the US government remains committed to repatriating US citizens during this crisis. However, the continued operation of international commercial air service remains uncertain, and the US government cannot guarantee that it will be able to coordinate charter flights in the future. The United States has repatriated 27,572 Americans from nearly 60 countries since the end of January.  
EFFECTS OF SOCIAL DISTANCING Data from internet-connected thermometers suggest that social distancing measures implemented nationwide in the United States could be working. The thermometers, manufactured by Kinsa Health, automatically upload temperatures taken to a centralized database. Data collected over the past several weeks show a decrease in the number of fevers that corresponds to expanded social distancing measures. Reportedly, the company has documented as many as 162,000 temperature readings per day since the US COVID-19 epidemic began. The company has demonstrated in the past the ability to rapidly detect elevated influenza activity using collected temperature data, and the current data provides sufficient resolution to observe trends in some regions, states and cities.
COVID-19 IN PRISONS Yesterday, we reported on new US CDC guidance for vulnerable populations, including pregnant women, individuals experiencing homelessness, and hemodialysis patients. Health officials and advocates at the state level have recently begun to proactively address another vulnerable population, prisoners and inmates. The living conditions in jails and prisons, including prolonged close contact and variable hygiene and sanitation standards, place these populations at elevated risk for transmission of communicable diseases, particularly respiratory infections. Some states have already taken steps to reduce incarcerated populations, particularly those at elevated risk for severe COVID-19 disease. For example, California is expediting the release of individuals that will soon be eligible for parole, which could facilitate the release of 3,500 prisoners. Connecticut published a plan to release eligible inmates a week before it reported its first COVID-19 case in an incarcerated individual. Nebraska suspended visitation and implemented programs to ensure that no more than 10 people occupy any space to reduce transmission. Additionally, Nebraska’s Cornhusker State Industries, a work program for inmates, has begun producing hand sanitizer, gowns, and facemasks for use by the Department of Correctional Services and other government agencies. 

VENTILATOR SHORTAGE Hospitals across the United States, and around the world, face the prospect of a shortage of life-saving ventilators in the coming days or weeks, if they are not already affected. The US government recently invoked the Defense Production Act in an effort to speed production and delivery of ventilator units by General Motors, but a number of other companies and organizations are actively pursuing alternative sources and products to mitigate the shortfall. Elon Musk announced yesterday that his company Tesla purchased 1,200 surplus ventilators from China, which will be distributed free of charge to hospitals in need. Researchers at the Massachusetts Institute of Technology revived a project from several years ago to develop a makeshift ventilator using “ambu” resuscitation bags, widely available at hospitals around the world. The team intends to share its design instructions free of charge, which will allow others to construct their own unit, using US$400-500 in supplies. The units are not currently FDA-approved, but the team hopes to obtain approval in the future. Employees at 2 General Electric facilities in Massachusetts reportedly staged protests to demand that they be able to manufacture ventilators. The facilities, originally designed to produce aircraft jet engines, are currently sitting idle, and the workers want those facilities to be converted to manufacture ventilators. The protests follow an announcement by GE that it will lay off 10% of its “domestic aviation workforce” as well as “temporary” layoffs for maintenance personnel in an attempt to save the company money. Additionally, several other companies announced that they would begin producing a “simplified version of GE Healthcare’s” ventilators.
In addition to a shortage of ventilator units themselves, hospitals are also facing a shortage of the medications needed to use them. In order for a patient to be put on a ventilator, they must be sedated. According to an article published by STAT News, more than a dozen drugs are currently in short supply—including “sedatives, anesthetics, painkillers, and muscle relaxants”—due to increased demand. Like much of the healthcare supply chain, hospitals and health systems do not maintain much excess inventory of these products, so any increase in demand poses challenges. Like the traditional ventilators, however, there may be alternatives that could mitigate these shortages. For example, a small company in Texas produces “helmet-style ventilation devices” that do not require the invasive procedures required to insert a breathing tube. Reportedly, these helmets have shown promise in previous studies, and Italian clinicians have indicated that they provide benefit for COVID-19 patients. While the units do not function like actual ventilators, products like this could potentially be used for patients with respiratory symptoms who do not yet require mechanical ventilation.
NEW YORK CITY FIELD HOSPITAL Mount Sinai Hospital in New York City partnered with the Samaritan’s Purse humanitarian response organization to construct and operate a field hospital in Central Park. The hospital will provide overflow capacity for COVID-19 patients at Mount Sinai, providing an additional 68 beds. Construction on the hospital, consisting of 14 tents shipped from North Carolina, reportedly began on Sunday, and the hospital is operational as of today.
DEPARTMENT OF DEFENSE COVID-19 REPORTING The US Department of Defense has instructed military units, bases, and Combatant Commands to cease reporting detailed COVID-19 data due to concerns about national security. Defense officials at the Pentagon indicated that detailed data on cases for specific bases, units, or regions could signal potential vulnerabilities. The Defense Department will continue to report aggregated COVID-19 data. The announcement follows recent reports about outbreaks onboard the USS Theordore Roosevelt aircraft carrier and the Marines’ training center in Parris Island, South Carolina, as well as the reported death of a National Guard member in New Jersey.

//inserted by Sharon